PONE-D-23-03153Preeclampsia and its determinants in Ethiopia: Systematic review and meta-analysisPLOS ONE

Dear Dr. Kassa,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. While the efforts made by the authors in preparing this manuscript are to be appreciated, I would encourage them to address all the editor and reviewer comments to the best of their abilities. In addition, please make sure to address the query regarding the novelty and clinical usefulness of this article compared with the ones published before since this is a major issue. 

Please submit your revised manuscript by May 25 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Aymen Ahmed

Guest Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

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Additional Editor Comments:

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Given that there are similar systematic reviews and meta-analyses conducted on this topic, can the authors please justify the need for this study to be conducted? What is the novelty of their research? How is it different from prior meta-analyses and what is it significantly adding to the current literature? Also please add the clinical implications of your findings.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Authors conducted a meta-analysis to determine the prevalence and determinants of preeclampsia in Ethiopia. Manuscript is well written; tables and figures are well made. I have few comments to improve the current version.

Abstract

1. Please replace “therefore” or “hence” with “as a result” in the background section.

2. The following sentences can be merged for sake of conciseness and clarity.

“A systematic review and meta-analysis were conducted on observational facility-based studies between the years January 1, 2013, and January 1, 2023, in Ethiopia. Electronic searches such PubMed, Google Scholar, HINAR, Scopus, Web of Sciences and grey literature were used to 37 search primary studies.”

3. Use of the word “such as” gives an impression as if not all the databases that were searched to identify articles are mentioned. If that is the case, please mention all the databases in methods or eliminate the phrase.

4. Please mention the name of “Standardized measurement tool” that was used to extract data.

5. “STATA 11 statistical software was used to analyze the data as well and I2 tests evaluated study heterogeneity”

Please delete as well from this sentence.

6. Were there p-values along with AOR? They maybe worth mentioning in the results.

7. Conclusion is too big for abstract please try stating conclusions in maximum of 2-3 short sentences. This conclusion is too big for whole manuscript as well. Consider rephrasing.

Introduction

1. It might be worth mentioning exact figures of worldwide prevalence of preeclampsia.

2. Current version of introduction is very long and provides very general details regarding preeclampsia. Please shorten it and focus more towards building rationale of this particular study.

Methods

1. All studies were published in Ethiopia? Or all studies were conducted in Ethiopia?

2. Please state the criteria for including studies in a paragraph form.

3. Why were studies not taken from inception and taken from January 2013?

Results

1. Results are well described. Please mention the t value for egger’s test if it is available.

2. Replace Magnitude of Preeclampsia with Magnitude of Preeclampsia Prevalence or equivalent.

3. Semi colon is not correctly used. Please correct grammar throughout.

4. Please mention p-values alongside AOR for determinants, if available.

Conclusion

1. Please shorten the conclusion. Currently it provides a lot of redundant details. It should be one single paragraph, providing all the takeaway points.

Reviewer #2: 1. Please structure the Methods section under the headings of Search strategy, Study selection criteria, Screening process and data extraction, Extracted parameters, Quality assessment (ROB), and Statistical Analysis.

2. Please indicate how the screening of articles was done in more detail such as which reviewers performed the screening.

3. Kindly explain the rationale behind “Variables were chosen for this study if they were reported as a significant factor in two or more studies.”

4. In line 130, please make the phrase “up to December January 1, 2023” clearer.

5. The part concerning operational definitions should be mentioned under the heading of “Extracted parameters”.

6. There are grammatical errors in various places throughout the text, please correct them.

7. State the full forms of all abbreviations the first time they are used in the text.

8. Please be precise while wording the results section.

9. Kindly improve the language of the Results section, while correcting for any grammatical and spelling mistakes. For example, in Lines 216 - 222.

10. Edits to be made to Line 62 - pregnancy induced hypertension and Line 72 – multiparous.

11. Kindly shorten the Introduction by avoiding repetition and by making it more concise.

12. Please remove/replace all references older than 10 years.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-23-03153R1Preeclampsia and its determinants in Ethiopia: A systematic review and meta-analysisPLOS ONE

Dear Dr. Kassa,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jun 17 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Aymen Ahmed

Guest Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

The authors have responded to the query regarding clinical implications of this article. However, no significant text pertaining to implications has been added to the main text of the manuscript. Kindly add clinical implication details to the discussion section of the manuscript wherever the authors feel it is appropriate. Please ensure that the flow and coherence of the discussion text is maintained.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All of my comments have been addressed except for few

1. Request to mention p-values alongside AOR throughout the manuscript. Authors mention that p-values are not required with AOR, which is not correct. P-value is absolutely needed to determine whether the stated association is statistically significant or just by chance and hence ignorable. Therefore, it is advised to please mention p-values throughout.

2. In abstract please explicitly mention you used Microsoft Excel. "Standardized data collection tool" is not sufficient information.

3. In methods section, please specifically mention the reason you included article between 2013 and 2023.

Reviewer #2: The authors have improved upon the quality of their article. I have some minor comments to make, after which I believe the article would merit publication. These comments are as follows;

1. I believe the Introduction section can still be restructured in a better manner.

2. Line 75-76: Rephrase as "Global studies reveal that the incidence of pre-eclampsia in nulliparous females ranged from 3 to 10% while in multiparous women, the incidence of preeclampsia ranged from 2 to 5%"

3. Line 91 - It should just be stated that "Preeclampsia and eclampsia are associated with hypertension and are known to poorly impact maternal and newborn mortality and morbidity"

4. In Lines 93-95, the first sentence and the phrase, "increases caesarian delivery rate", need to be rephrased.

5. Line 99 - The term "hypertension problems in women" needs to be better phrased.

6. Line 109 - Is it "across each region" or across various regions in the state?

7. Line 132 - Replace "whereas" with meanwhile.

8. Line 166 - Rephrase "through a two investigator (BCD and SA)"

9. Line 168 - kindly mention that it is an MS Excel sheet that includes (not "considers") data concerning the variables stated in the text.

10. Line 199 - Please replace "done to find" with "performed to ascertain"

11. Line 205 - Please edit it as "Of these articles, 972 duplicates were eliminated while 1536 articles were reviewed further for inclusion"

12. Line 216 - Specify Figure or Table along with S2. Additionally, exclude "see" from all brackets in the entire text where you are referring to a table or figure.

13. Line 220 - It should be "reported" instead of "report"

14. Line 225 - Use indicating instead of "showing".

15. Line 227 - Incorporate the t value for Egger's regression test.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Muhammad Sameer Arshad

Reviewer #2: Yes: Warda Ahmed

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Preeclampsia and its determinants in Ethiopia: A systematic review and meta-analysis

PONE-D-23-03153R2

Dear Dr. Kassa,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Aymen Ahmed

Guest Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2:  All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: (No Response)

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: (No Response)

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: (No Response)

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: The authors have addressed all my comments. 

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Warda Ahmed

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